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PAR2011 - ALS > Week 5 > Flashcards

Week 5 Flashcards

1
Q

The lungs are surrounded by 2 continuous pleural membranes called the what?

A
  • Visceral pleura attached to the lungs

- Parietal pleura attached to the thoracic cage

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2
Q

How long is the trachea and it’s diameter?

A

10 -12cm

2.5cm in diameter

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3
Q

What is the trachea made of?

A

Contains 16-20 cartilaginous C-rings, composed of hyaline cartilage

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4
Q

What do the C rings in the trachea do?

A

Maintain structure and prevent collapse

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5
Q

What is the last trachael cartilage called?

A

Carina.

has Highly sensitive mucose which causes violent coughing when irritated.

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6
Q

Where does the primary bronchi begin?

A

Primary bronchi divides at the carina

  • Occurs at T7 of spine
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7
Q

what is a Difference between right and left bronchi?

A

Right bronchus is shorter, wider

and more vertical than the left

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8
Q

What are the 3 functional components of the respiratory system?

A
  • Gas exchange
  • Air pump - Mechanics of breathing
  • Regulation - Driver of ventilation
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9
Q

What are the steps air from the atmosphere goes through to enter the airways and system?

A
  • Conducted through nose/muth
  • Down larynx
  • Down trachea
  • into bronchus
  • down to a bronchial
  • then to a terminal bronchial
  • then terminal bronchial unit
  • into alveoli
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10
Q

Where does gas exchange begin?

A

Terminal respiratory units (TRUs)

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11
Q

What are the bronchioles made of?

A

Walls consist of smooth muscle

  • They do not have connective tissue or cartilage
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12
Q

Gas exchange only occurs in the:

A
  • Terminal bronchioles
  • Alveolar ducts
  • Alveolar sacs
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13
Q

What happens if Alveoli is overinflated?

A

Can cause gas leakage into the surrounding lung tissues and possibly the thoracic cavity

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14
Q

What is the atmospheric pressure at sea level?

A

760mmHg

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15
Q

What is the oxygen content of atmospheric pressure at sea level?

A
  1. 9%

- 159mmHg

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16
Q

What is the CO2 content of atmospheric pressure at sea level?

A
  1. 04%

- 0.3mmHg

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17
Q

What are the 2 types of respiration?

A

External respiration
- exhcnahge of O2 & CO2 between alveoli and blood

Internal respiration
- exchange of O2 & CO2 between blood and tissue cells

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18
Q

What are the 2 forms that O2 is carries by in the blood?

A
  • Dissolved (1.5%)

- Attached to Hb (98.5%)

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19
Q

Which form of oxygen in blood can diffuse out of capillaries into cells?

A

Only the dissolved O2

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20
Q

What is required for O2 to dissociate from Hb and dissolve into Plasma for cellular diffusion?

A

Plasma O2 levels must always be greater than cellular O2 levels

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21
Q

What are the factors that influence O2 binding to Hb

A
  • pH
  • PCO2
  • Temperature
  • 2, 3-BPG ((Biphosphoglycerate –
    binds to haemoglobin,
    increases ability of
    haemoglobin to release O2)
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22
Q

How much CO2 is produced per minute in the body?

A

200mls

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23
Q

How is CO2 transported around the body?

A
  • Dissolved in plasma (7-10%)
  • Bicarbonate ion in plasma (about 70%)
  • Carbaminohemoglobin (20%)
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24
Q

How does alveolar ventilation impact the regulation of breathing?

A

Alveolar ventilation affects the level of CO2, which impact H+, which impacts regulation of breathing

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25
Q

What muscles are used for Inspiration?

A
  • Diaphragm

- External intercostals

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26
Q

What muscles are used for Expiration?

A
  • Internal intercostals

- Abdominal

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27
Q

Whats another name for the pleural space?

A

Potential space

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28
Q

How do the 2 pleural membranes remain adhesive force?

A

Contains 3-5mls of serous fluid

  • constantly being excreted and absorbed
  • allows strong adhesive force
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29
Q

What creates the Negative Intrapleural pressure?

A

Results because the chest wall exerts pressure to pull the parietal pleura outward, while the elastic fibres in the lungs pull the visceral pleura inward

  • The constant pull of the pleural membranes causes pressure in the space to be SUBATMOSPHERIC
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30
Q

What causes pneumothorax?

A

atmospheric pressure entering the pleural space

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31
Q

What is the average adult Tidal volume?

A

500mls

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32
Q

What is tidal volume?

A

Breathing out

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33
Q

What is the formula for the minute volume?

A

MV = Tidal vol X resp rate

34
Q

What is distensibility?

A

The ease of expanding the lung

35
Q

What is resistance to airflow in the lungs dependant on?

A

Pulmonary compliance

36
Q

What is pulmonary compliance?

A

Change in lung volume relative to a given pressure

37
Q

What can reduce pulmonary compliance?

A

can be reduced due
to degenerative lung diseases such as TB and pulmonary
fibrosis.

– Reduced compliance will affect how you ventilate a patient

38
Q

Where is breathing regulated?

A

Brainstem, medulla, pons

39
Q

What nerve regulates major output of breathing?

A

Phrenic nerve

40
Q

What systems work together to form spontaneous ventilation and resp rate?

A

Ventral respiratory group (VRG)

+

Dorsal respiratory group (DRG)

41
Q

What do central chemorecpetos detect when regulating breathing?

A

PCO2 + H+

Not PO2 of blood`

42
Q

Where are the central chemoreceptors located for regulating breathing?

A

Ventral surface of the medulla

43
Q

Where are the peripheral chemoreceptors located for regulating breathing?

A

carotid bodies at the bifurcation of common carotid arteries and below the aortic arch

44
Q

What do peripheral chemorecpetos detect when regulating breathing?

A

decreases in arterial PO2 and pH

increases in arterial PCO2

45
Q

What other types of receptors exists with breathing regulation?

A

Lung receptors - Located in walls of bronchi and brochioles

Pulmomary stretch receptors

Irritant receptors

J receptors - live in alveoli walls - stimulate ventilation in response to engorgement from interstitial fluid

46
Q

What is the primary driver in ventilation?

A

PCO2 in arterial blood

47
Q

What chemoreceptors are involved in hypoxia and hypoxaemia?

A

only peripheral receptors

48
Q

What is the normal Tidal volume for an adult?

A

500mL

49
Q

Why do we provide assisted ventilation?

A
  • help maintain normal partial pressures of O2 and CO2

- create positive partial pressure that pushes air into lungs

50
Q

What happens to an indicated patient if you fail to provide adequate ventilation?

A
  • Lead to hypoxia
  • CO2 retention
  • Development of acidosis
  • cardiorespiratory arrest
51
Q

What are the indications for assisted ventilation?

A
  • where spntaneous ventilation is inadequate or absent
  • Pts with life threatening respiratory emergency
  • > resp failure or resp distress
52
Q

What are some symptoms of pt’s in resp failure?

A
  • do not show work of breathing as exhaustion has overridden
  • show signs of hypoxia and hypercapnia
  • decreased, asymmetrical or absent breath sounds
  • O2 sats < 90% on room ait, <92% on O2
  • Tachycardia >120 or bradycardia as a late sign
  • Arrhythmias
  • Pallor and/or cyanosis
  • Cool pale clammy
  • Falling BP (late sign)
  • Changed GCS
  • Decreased consciousness
  • Exhaustion (+/- chest pain)
53
Q

what can cause the chest NOT to rise during assisted ventilation?

A
  • Obstruction in the airway
  • Insufficient volume of gas being blown into lungs
  • inadequate seal of mask
54
Q

What are the sizes in mls of the Bag valve mask (BVM’s)

A
  • Adult - 1400 - 1600 mks
  • Paed - 500mls
  • Neonate - 240 mls
55
Q

How many breaths per minute should you aim for with assisted ventilations?

A

12 - 16

56
Q

If a patient has 8 breaths how many ventilation do you give in assisted ventilation?

A

4 - 8

57
Q

How much oxygen to give to patients in assisted ventilations

A

10ml per kg

58
Q

What are some problems associated with Assisted ventilation?

A

Positive pressure ventilations have been assciated with:

  • Decreased oxygenation
  • Gastric rupture
  • Lung injury
  • hyperventilation
59
Q

Define aspiration

A

the inhalation of material into the airway below the level of the vocal cords

60
Q

What acts as a valve preventing gastric reflux?

A

Lower oesophageal sphincter

61
Q

What is barrier pressure?

A

the pressure difference between the Lower Oesophageal sphincter and the intragastric pressure.

  • Usually 25mmHG LOS
    and 10mmHG intragastric pressure
62
Q

What is aspiration pneumonitis?

A

lung tissue damage as a result of aspiration of very acidic gastric fluid

63
Q

What is aspiration pneumonia

A

result of inhaling infected material or bacterial infection

64
Q

What is hyperventilation?

A

a negative intrathoracic pressure is created forcing air into the lungs

  • can impact the diameter of vena cava and cardiac chambers
  • > acts as thoracic pump drawing blood into the heart
65
Q

Hyperventilation has been associated with decreased what?

A

decreased coronary and cerebral perfusion pressures

66
Q

Hoew does hyperventilation affect coronary perfusion?

A
  • Normally negative intrathorcacic pressures apply traction to the greater vessels leading to more venous return
  • non-typical respiratory activity affects the ability of thoracic pump and reduces venous return and CO
  • Greater vessles are down compressed by the positive pressure ventilation (PPV) leading to less venous return
  • in turn reduces coronary perfusion
67
Q

What is capnography?

A

monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases.

68
Q

What is the benefit of capnography?

A

provide clinicians with a sensitive indicator to the effectiveness of compressions and ventilation performance

69
Q

What is End tidal CO2 (ETCO2)?

A

the maximum partial pressure of CO2 at end of breath

70
Q

What is the value mmHG of ETCO2?

A

about 26-40mmHG in health adult

71
Q

What does PaCO2 mean?

A

partial pressure of CO2 in the arterial blood

72
Q

What is the normal range for PaCO2?

A

approx 35 - 45 mmHG

  • 3-5 mmHG higher than ETCO2
73
Q

What is a capnogram?

A

the plot of ETCO2 vs time

74
Q

What is the normal value of CO2 in the body?

A

35 - 45mmHG

75
Q

What is the normal range of ETCO2 compared to CO2 in the blood?

A

Within 5mmHG

76
Q

What is it called if ETCO2 is over 45mmHG?

A

Hypercapnia

77
Q

What is it called if ETCO2 is under 35mmHG

A

Hypocapnia

78
Q

What are the causes of Hypocapnia?

A
  • Hyperventilation
  • Hypoperfusion
  • hypothermia
79
Q

What causes hyperventilation?

A

When a patient blows off more CO2 than they’re making

80
Q

What information does a capnography provide?

A

Ventilation
- How effectively CO2 is being eliminated by the lungs

Perfusion
- How effectively CO2 is being transported through the vascular system

Metabolism
- how effectively CO2 is being produced by cellular metabolism

81
Q

WHat will paramedics use capnography to determine?

A
  • Loss of ETCO2 may be first sign CPR is needed
  • Compression feedback
  • Guide ventilation rates and confirm airway placement through waveform capnography
  • Help determine when to terminate or continue CPR
  • Spike in ETCO2 is first sign of ROSC

PAR2011 - ALS (11 decks)

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